Advanced Search

Part B Insider (Multispecialty) Coding Alert

Drug Payments:

Medicare Adjusts Dozens of Drug Payments

Published on Sat Sep 13, 2003 Print Friendly and PDF PDF

If your practice bills Medicare for lots of prescription drugs, then it's time to update your pricing charts.
 
Part B carrier Cigna posted the fourth-quarter drug payment updates, which take effect Oct. 1, on its Web site. The Centers for Medicare & Medicaid Services sets national prices for drugs furnished incident-to a physician's services using its Single Drug Pricer methodology.
 
Among the drugs that received increases were:

  • 90645 (hemophilus influenza B vaccine), which increased to $25.38
  • 90704 and 90705, mumps and measles vaccines, which rose  to $19.43 and $15.03 respectively.
  • 90732 (pneumococcal vaccine), raised to $18.62
  • J0282 (amiodarone hydrochloride, 30 MG), up to $15.94.
  • J0456 (azithromycin, 500 MG), raised to $25.55
  • J0500 (dicyclomine HCl, up to 20 MG) raised to $17.06
  • J0600 (edetate calcium disodium), raised to $44.10
  • J0850 (cytomegalovirus immune globulin intravenous), up to $712.07
  • J1190 (dexrazoxane hydrochloride), raised to $233.97
  • J1410 (estrogen, conjugated), up to $61.51
  • J1460-J1550 (gamma globulin), raised to $12.17 per unit
  • J1670 (tetanus immune globulin), raised to $119.70
  • J1950 (leuprolide acetate), up to $517.32
  • J2324 (nesiritide), up to $151.62
  • J2770 (quinupristin/dalfopristin), up to $114.58
  • J2910 (aurothioglucose), up to $17.31
  • J2941 (somatropin), up to $45.92
  • J2993 (reteplase), raised to $1364.44
  • J2997 (alteplase recombinant), increased to $36.70
  • J3100 (tenecteplase), which rose to $2690.88   
  • J9160 (denileukin diftitox), which rose to $1330.95
  • J9185 (fludarabine phosphate), which rose to $356.07
  • J9216 (interferon gamma 1-B), which rose to $209.22
  • J9266 (pegaspargase), which went up to $1543.75
  • J9310-J9320 (rituximab and streptozocin), up to $501.13 and $141.47
  • Q0187 (factor VIIa), rose to $1681.50
     
    Among the drugs reduced were:
  • 90385 (Rho[d] Ig (RhIg) minidose, IM), which went down to $34.77
  • J1056 (medroxyprogesterone acetate/estradiol cypionate), reduced to $24.61
  • J1120 (acetazolamide sodium), reduced to $20.52
  • J1742 (ibutilide fumarate), down to $251.35
  • J2020 (linezolid), down to $36.80
  • J2545 (pentamidine isethionate), lowered to $50.77
  • J2760 (phentolamine mesylate), down to $31.92
  • J2788 (Rho d immune globulin, human), down to $34.77
  • J3315 (triptorelin pamoate), reduced to $398.62
  • J7317 (sodium hyaluronate for intra-articular injection), lowered to $138.71
  • J7504 (lymphocyte immune globulin, antithymocite globulin), down to $278.70
  • J9040 (bleomycin sulfate), which went down to $182.40
  • J9062-J9094 (cisplatin, cladribine and cyclophosphamide)
  • J9180 (epirubicin hydrochloride), decreased to $690.99
  • J9206 (irinotecan), which dropped to $145.74
  • J9280-J9291 (mitomycin), which dropped to $63.84, $207.48 and $285
  • HCPCS J9390 (vinorelbine tartrate), down to $89.36
     
    CMS also added two new drug codes: Q4076 (dopamine hydrochloride) and Q4077 (treprostinil), which reimburse at $0.62 and $37.05 respectively.

    • Other Articles in this issue of

    Part B Insider (Multispecialty) Coding Alert

    View All